OBJECTIVES: Medication reconciliation(MR)is relevant in the transitional care, however, given the limited resources, it is necessary to identify the patients who can benefit most from this activity. Our aim was to validate the criteria that identify patients at high risk of experience medication errors and error-related adverse events undergoing major orthopaedic surgery.

METHODS: The Delphi technique was used through a questionnaire carried out in 3 phases (April-June 2023)to obtain consensus on the inclusion criteria. These were previously defined by a multidisciplinary team, based on the probability of risk of the adverse event to happen.Each expert rated the criteria according to a 5-point Likert scale, and consensus was assumed if 50% of the mean responses were ≥4 (inclusion) or <2 (exclusion). It was possible to suggest the inclusion of new criteria.

RESULTS: 10 experts from 4 Faculties of Pharmacy and Medicine were invited. In the first phase,9 responses were obtained and consensus was reached on 18 criteria: polypharmacy, anticoagulants, oral chemotherapy (not hormone therapy),immunosuppressants,antiretrovirals, (pyridostigmine and neostigmine),insulin, corticoids, neuroleptics, antiarrhythmics, digoxin, carbamazepine, phenytoin, valproate, thyroid drugs, anti-glaucoma therapy, anti-aggregants and urgent surgery. Systemic antifungals and opioids were suggested. In the second phase, 8 experts responded. Consensus was reached on 6 criteria: anti-parkinsonics, beta-blockers, age ≥65 years, length of stay ≥5 days, opioids and systemic antifungals. In the last phase, 6 experts responded and 1 criterion reached consensus: sulfonylureas. At the end,3 criteria did not reach consensus: anxiolytics, angiotensin converting enzyme inhibitor or angiotensin II receptor antagonists and calcium channel blockers.

CONCLUSIONS: We developed and validated a list of 25 criteria to identify patients at high risk of experience medication-related adverse events undergoing major orthopedic surgery. These criteria may help improve human resource management for clinical pharmacy activities by prioritizing patients who would benefit most from MR. This methodology could be replicated in other clinical areas.